The invention relates generally to methods of securing disability insurance benefits and, more specifically, to novel methods, generally configured with computer and software technology, of securing Social Security disability insurance benefits, recovering overpayments of disability insurance benefits made to a disabled individual, providing additional services to the disabled individual after securing Social Security disability insurance benefits, and providing financial assistance for the disabled individual during the pendency of their disability insurance claim with the Social Security Administration.
The inventor's core business consists of representing individual claimants before the Social Security Administration (SSA) for purposes of obtaining Social Security disability insurance benefits (SSDI). Traditionally, the inventor's primary customers (clients) are insurance carriers that write long-term disability (LTD) policies and self-insured employers who desire to reduce their long-term disability expense by obtaining SSDI for their policy holders or their individual employees. In connection with the provision of services to his clients, the inventor has developed new business methods to provide such services utilizing sophisticated computer programs, databases and electronic fund retrieval methods.
On average, it takes SSA thirteen months to process a claim for SSDI. Once SSDI is awarded, generally there is a retroactive benefit representing disability payments that should have been paid by the SSA beginning with the sixth full month an individual is off work due to disability. LTD plans are designed to offset the LTD benefit upon the disabled individual's receipt of SSDI. In other words, once SSDI is obtained for a claimant, the LTD is reduced. However, full LTD benefits are paid until the SSDI is awarded. Generally, the disabled employee signs an agreement to repay any overpayment created by the award of retroactive SSDI. A portion of the retroactive SSDI, therefore, is due to the LTD plan as repayment of this overpayment.
For example, a disabled individual is receiving $1,400 per month in LTD. After 18 months, SSA awards disability benefits of $1,000 per month. SSA issues a retroactive check for 12 months of benefits (SSA does not pay during the 5-month waiting period) or $12,000. Based on the plan design the disabled employee's LTD benefit will be reduced by $900 per month, for a net LTD benefit of $500. Since the disabled individual was paid $1,400, he or she would owe the plan $900×12 months, or $10,800.
Additionally, the disabled individual receives a number of financial advantages upon receipt of SSDI:
Increased Monthly Income
Although the initial SSDI may be offset by other disability or retirement benefits the disabled individual already is receiving, the SSDI cost-of-living increases may not. Thus, the combined benefits may increase each year when SSDI cost-of-living increases are paid.
Increased Retirement and Survivors' Benefits
Social Security disability entitlement “freezes” the Social Security earnings record. Social Security regulations stipulate that any years “wholly or partially within a period of disability” will be excluded from the computation of future benefits. Thus, the amount of eventual Social Security retirement benefits, dependents' benefits, or even a subsequent disability or survivors' benefits, may be higher because these lost years of earnings will not be considered in future computations.
Medicare Coverage
After the individual has received SSDI for twenty-four months, regardless of age, he or she also becomes eligible for Medicare benefits. This includes Part A hospital benefits and Part B medical benefits.
Surviving on lower income with mortgages, car payments and other debts is frightening to disabled individuals. When they receive a large check for retroactive benefits, it is difficult to resist the temptation or necessity to use the money to improve their situation. LTD plans were experiencing difficulty collecting this overpayment. The plans were using a variety of collection scenarios:                1. Hope for a lump sum payment by the disabled individual;        2. Recover the overpayment from future benefits ($10,800÷ $500=21.6 months); or        3. Refer the individual to a collection agency.        
Scenario 1 generally yields a collection rate of 45% to 65% depending on the dollar value of the overpayment. Overpayments of under $10,000 were paid more readily than amounts over $10,000. Scenario 2 only worked if the individual remained on claim long enough to collect the total amount owed. Too often the individual went off claim due to age or death. Additionally, the LTD plan fiduciary lost the time value of money. Worst case is scenario 3, which yields only $0.50 to $0.60 on the dollar. Scenarios 2 and 3 did not promote a positive relationship with the disabled individual. Hence, the inventor recognized the need for assistance in, and a method for, the enhanced recovery of the overpayment.
Furthermore, businesses today are accelerating efforts to reduce direct and indirect costs associated with disability, as well as the related health and legal expenses. Too often that means loss of health insurance and prescription drug coverage to the disabled individual. Additionally, the disabled individual has many financial concerns upon disability. The inventor recognized the need for someone to interact with disabled individuals in the delivery of services and additional assistance after it has completed its standard Social Security and Medicare services. These individuals require a variety of services that are not currently offered as a package of benefits in the industry or through their previous employer. Through surveys with the disabled individuals and their employer clients, the inventor has recognized a need for a package of services to assist the disabled individual after award of SSDI.
The inventor has recognized that qualifying for SSDI is just one step in coping with the practical and financial challenges of disability. The individual still has to consider other life and financial issues. These issues include the following:                Social Security Review—Upon receipt of SSDI, SSA establishes a diary for review of an individual's medical condition.        Social Security Related Tax Decisions—Payment of premiums for LTD has an impact on taxation of the LTD benefit. Once the disabled individual begins to receive SSDI it changes that tax structure.        Disability Related 401(k) Decisions—Plan designs will determine if the disabled individual can leave their 401(k) assets with their employer or if they must move the funds to a self-directed IRA or other investments. Additionally, the disabled individual may need to make withdrawals.        LTD or Workers' Compensation Settlement Assistance—Receipt of SSDI may lessen the dependency on other benefit plans. The disabled individual may desire settlement of other benefits in order to receive a lump sum of money for investments, revisions needed to their home or education for themselves or their dependents.        COBRA Extension—Often the disabled individual is only offered COBRA through their previous employer. Once the SSDI is awarded, the individual may qualify for COBRA extension. This affords them health insurance protection until Medicare entitlement begins.        Medicare and Health Insurance—For employers who do extend group health insurance throughout the disability, utilization of dual health plans is very confusing to the disabled individual. Often, they will continue to use the employer health plan due to familiarity, even though a better benefit would be available by using Medicare as primary and their employer group health plan as the secondary payer.        Expensive Prescription Drugs—Medicare does not cover prescription drugs except in very limited circumstances. Even some employers who do extend health insurance, do not extend prescription drug coverage to disabled employees.        Return to Work Information—If the disabled individual wants to return to work there is a fear of losing benefit coverage.        
Finally, in the course of representing uninsured disabled individuals, the inventor recognized that a disabling event affects the disabled individual's life both physically and mentally and leaves him or her with the sense that his or her life is out of control. Although the individual may be entitled to SSDI, on average it takes thirteen months to process a SSDI claim. The likelihood of an uninsured, disabled individual being able to obtain credit or funds from other third-party sources is questionable. Without a sufficient alternative means of support, the individual is presented with immediate financial concerns. The inventor has recognized the need to alleviate the financial concerns of the disabled individual to the extent reasonably possible and to provide a means by which such individual may continue to meet his or her basic needs.
Based upon the foregoing, therefore, it would be advantageous to provide a method of obtaining SSDI, recovering any overpayments of LTD benefits for a client insurance carrier or employer, providing post-award services and savings for the disabled person or client company, and providing financial assistance for disabled individuals during the pendency of their claims.